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Rev.02 Date 07/19 <br /> Receiving Form 001 <br /> AiiR'` 1I, 4 � rr•; <br /> SAMPLE RECEIVING REVIEW SHEET <br /> Batch/Work Order#: <br /> Client Name: Project: <br /> Delivered by: D Client D SunStar Courier 0 GSO D FedEx D Other <br /> If Courier,Received by: Date/Time Courier <br /> Received: <br /> Lab Received by: Date/Time Lab <br /> Received: <br /> Total number of coolers received: i Thermometer ID: e-r Calibration due : 6/27/20 <br /> Temperature: Cooler#1 3.•1 °C+/-the CF(+ 1.2°C) .= I/& °C corrected temperature <br /> Temperature: Cooler#2 °C+/-the CF(+ 1.2°C) = °C corrected temperature <br /> Temperature: Cooler#3 °C+/-the CF(+ 1.2°C) = °C corrected temperature <br /> Temperature criteria=:5 6°C <br /> Within criteria ❑No <br /> no frozen containers) .. ®Yes. <br /> If NO: <br /> Samples received on ice? []Yes []No > <br /> Complete Non-Conformance Sheet <br /> If on ice,samples received same day Dyes Acceptable []No 4 <br /> collected? Complete Non-Conformance Sheet <br /> Custody seals intact on cooler/sample DYes ONo* ON/A <br /> Sample containers intact -QYes ONo* <br /> Sample labels match Chain of Custody IDs RYes ONo* <br /> Total number of containers received match COC QYes. ONo* <br /> Proper containers received for analyses requested on COC ®Yes ONo* <br /> Proper preservative indicated on COC/containers for analyses requested DYes ONo* QN/A <br /> Complete shipment received in good condition with correct temperatures, <br /> containers,labels,:volumes preservatives and within method specified 9 Yes []No* <br /> holding times <br /> *Complete Non-Conformance Receiving Sheet if checked Cooler/Sample Review-Initials and date: <br /> � /z•!4•t4 <br /> Comments:• <br /> Page 1 of t <br /> (949).'297-502.0 0 www.sunstarla.b.s.com - 1 <br />